| Objective:This study aims to explore the better treatment for the type of constipation through recent and forward observations and analysis of clinical curative effects, by using two different surgical procedures of rectal prolapse with circumferential mixed outlet obstruction constipation, and through the objective evaluation,which has been made for the situation of preoperative and postoperative anal function from anorectal manometry. Methods:This study consists of the three parts as follows. The first one:the comparative analysis of the characteristics of108cases outlet obstruction constipation caused by rectal prolapse with circumferential mixed hemorrhoid and the short and longterm safety and efficacy of two surgical approaches have been made through retrospective case-control analysis in Anorectal surgery in the First Affiliated Hospital of Xinjiang Medical University from April2010to October2011to explore the better treatment of the outlet obstruction constipation caused by rectal prolapse with circumferential mixed hemorrhoid further and to improve the patients’life quality and satisfaction degree. The second part:From December2011to May2012,100cases of rectal prolapse with circular mixed hemorrhoid patients, who were admitted in the hospital and divided into two groups by using a randomized block grouping method. The patients in the treat experimental group were performed by (procedure for prolapse and hemorrhoids)(PPH) and the controls by traditional approach,so called (milligan-morgan and the rectal mucosa ligation). Two groups were provided anorectal pressure test before and after surgery, respectively in order to analyze those changes of anorectal pressure and evaluation of anal function indicators.Under the normal circumstances,the Resting Rectal Pressure (RRP) data range is (1.8—5.3mmHg),the Resting Anal Pressure(RAP) data range is (13—54mmHg),the Anal Maximal Contraction Ressure(AMCP) data range is (30—190mmHg).Anorectal Incontinence will be caused if the RAP and the AMCP are too low,instead,the Anal Stricture will be occurred.Anorectal manometry worked as an objective evaluation and refer to the life quality evaluation to assess the different surgical anal surgery treatment. The third part from June2012to December:A prospective single-blind randomized controlled trial was made by the cases, undertest to the Anorectal surgery, for the obstruction constipation caused by rectal prolapse with circumferential mixed hemorrhoid2012. In the treatmental group were employed PPH combined in the Acupuncture, and the same number in control used PPH procedure alone. The efficacy and safety for these groups were alone comparaed study by observation of the following indicators:urinary retention, postoperative bleeding, perianal edema, postoperative VAS pain score, anorectal inhibitory reflex, anal diastolic, anal maximum systolic, anal resting pressure, rectal resting pressure, incontinence, anal stenosis, redundant skin, bowel problems, blood in the stool, recurrent prolapse, anal, improved quality of life, satisfaction degree. Results:In the first part of the retrospective study, the difference of general information and clinical characteristics of the two groups patients was not statistically significant, two groups were comparable.54patients were treated by procedure for prolapse and hemorrhoids and54by conventional surgery. Compared with the conventional surgery, the procedure for prolapse and hemorrhoids has obvious advantages both in the short term and the long term. Short-term effects:the shorter operative time, shorter postoperative hospital stay, less perianal edema, less postoperative pain, less postoperative bleeding,(all P<0.05); there was no significant difference in urinary retention (P>0.05). Long-term effects:lower skin tag occurrence, lower anal incontinence,(all P<0.05); higher anal bulge rate, but the differences were not statistically significant (P>0.05). In the study of anorectal pressure, the postoperative anorectal testing has been weakened in both groups. Each indicator of anorectal pressure of the patients in experimental group was not statistically significant both in preoperative and postoperative (P>0.05). It shows that the procedure for prolapse and hemorrhoids did not affect the patient’s anal function and change the normal anal function. Each indicator of anorectal pressure of the patients in control group was statistically significant both in preoperative and postoperative except the rectal rest pressure (P<0.05). The differences of experimental group and control group in preoperative and postoperative comparison were statistically significant except the rectal rest pressure (P<0.05). It shows that the the conventional surgery affected the patient’s anal function.Follow up the two groups and according to the standard of PAC-QOL,the PPH group shows better life quality than the others.Compared the PPH with the conventional surgery and based on the differences of the relative dimension and the total score there was statistical significance. In the study of procedure for prolapse and hemorrhoids combined with Acupuncture, compared with the control group, the short-term efficacy of experimental group:less urinary retention rate, lighter pain, less anal edema (all P<0.05), and there was no statistical significance in the differences of preoperative and postoperative anorectal pressure indicators (P>0.05); the long-term efficacy of experimental group effect:less recurrence of prolapse, less difficult defecation, less anal bulge, less blood in the stool (all P<0.05); satisfaction, quality of life, and there was no statistical significance in the differences of anal incontinence and anal stenosis (all P>0.05).Follow up the patients’ life quality trough the different treatment plan at the same time according to the standard of RAV-QOL, the PPH combined in Acupun cture group shows better life quality.Compared the society psychology and the satisfaction degree plus the difference of total score between the two groups shows the statistical significance. Conclusions:procedure for prolapse and hemorrhoids is obviously superior to conventional surgery for the outlet obstruction constipation caused by rectal prolapse with circumferential mixed hemorrhoid, but there are also many shortcomings. By objective evaluation system of anorectal manometry, the minimal invasion and safety of PPH was further confirmed.Also the PPH group can get better life quality. Compared with the traditional operation, its postoperative anal function affected less seriously. The procedure for prolapse and hemorrhoids combined Acupuncture will be a good treatment for the Outlet obstruction constipation caused by rectal prolapse with circumferential mixed hemorrhoid, and it is worthy of being promoted clinically. |
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